Contraceptive use dynamics of Asian women in Britain

Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study

INTRODUCTION

Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling.

METHODS

Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out.

RESULTS

Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception.

CONCLUSIONS

Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences.

Practice of and attitudes towards family planning among South Asian American immigrants

BACKGROUND

Previous studies performed outside of the US that examined contraceptive knowledge and beliefs in South Asian women identified significant barriers. Our study aimed to further understand these practices in this population residing in the US.

METHODS

This cross-sectional study surveyed women of all ethnicities receiving health care from either of two ambulatory practices in New Jersey from October 2011 to November 2012. Using chi-squared testing, the frequencies of contraceptive outcomes between South Asians and non-South Asians were compared.

STUDY DESIGN

There were 42 South Asian respondents and 143 non-South Asian respondents. Our results show that South Asians are statistically significantly less likely to routinely use contraception and that gaps in contraceptive knowledge appear to stem from multiple barriers, including family opposition and pressure from spouse or in-laws to have children, cultural prohibitions, fear of side effects and misinformation, lack of education/knowledge about contraceptives and difficulty in accessing contraception. These gaps in contraceptive knowledge were also found to be multigenerational, despite higher levels of education generally seen in the South Asian population.

CONCLUSIONS

Clinicians caring for South Asian women should acknowledge both the barriers and the lack of contraceptive knowledge in this population and provide culturally competent family planning information to them during all women's health encounters.

'Everybody is moving on': infertility, relationality and the aesthetics of family among British-Pakistani Muslims

It is now widely recognised that experiences of infertility are socially and culturally contingent. Drawing on reproductive narratives of 108 British-Pakistani Muslims living in Northeast England (collected from 2007 to 2010), we show that subjective experiences of infertility in this population can take many forms, from 'straightforward' childlessness to concerns about inability to fulfil a range of reproductive expectations, desires and obligations, regarding timing, gender balance and number of offspring. Extended family relations are pivotal in the processes through which reproduction (or lack thereof) becomes defined as problematic. Changing family aesthetics can thus shape individuals' experiences of infertility in important ways. A growing emphasis on conjugal relationships for some couples offers a greater range of reproductive possibilities (enabling, for example, a period of voluntary childlessness). For others, increasing nuclearisation of family life reduces the possibilities for extended families to 'plug the gap' by providing proxy-children and a normalised social role for infertile couples. Moreover, such social roles may be time-limited, creating serious challenges for the long-term childless, who find themselves caught 'betwixt and between' two disparate sets of values.

Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: evidence from a national probability survey

We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians.

Asian women's use of specialist Contraception, Sexual and Reproductive Health Services in Leicester, UK

BACKGROUND

There is evidence to suggest that Asian women in the UK have specific contraceptive and sexual health needs. It has been reported that Asian women may use less reliable contraceptive methods and that cultural influences can affect access to sexual health services. As part of a wider needs assessment project we compared Asian women's usage of our specialist Contraception, Sexual and Reproductive Health Services to that of non-Asian women.

METHODS

An anonymous questionnaire was offered to all service users between October and December 2007. Data were analysed separately for Asian and non-Asian women.

RESULTS

The response rate was low for Asian women with only 26% completing questionnaires. There were no significant differences between the groups for proportions of women attending for each contraceptive method. A smaller proportion of Asian women were using the service for contraception and a greater proportion were attending for other sexual health reasons compared to non-Asian women. Confidentiality, female staff and not wanting to see their general practitioner were stated more often as reasons for using our service by Asian women.

CONCLUSIONS

The National Strategy for Sexual Health and HIV emphasises the need for services targeted at ethnic minorities. Asian women use our clinics for a variety of their sexual health needs. Our service is used by some in preference to general practice, which may reflect ease of access and the perceived confidentiality that a dedicated Contraception and Sexual Health Service offers. These preferences should be considered by primary care trusts when commissioning services.

Contraception and women over 40 years of age: mixed-method systematic review

AIM

This paper is a report of a mixed-method systematic review to identify barriers to, and facilitators of, contraceptive needs and choices of women over 40 years old.

BACKGROUND

Women over 40 years of age who do not want to conceive have specific needs for contraception to prevent unwanted, unplanned and unintended pregnancies prior to menopause.

DATA SOURCES

Six databases were searched for published and grey literature from September 1997 to September 2007, along with the Cochrane Central Register of Controlled Trials. The Internet, professional networks and hand searching were also used.

REVIEW METHODS

Mixed-method synthesis using Evidence for Policy and Practice Information and Co-ordinating Centre phased design.

FINDINGS

Guidelines to inform clinical decision-making were located but did not take account of age-related social factors affecting women's choices or local service availability. Women's access to services and contraceptive choices were influenced by educational level, general awareness of available methods, fear of side effects, women's social standing, religious and cultural beliefs, personal control, and confidentiality. The main factors influencing compliance and continuation rates were knowledge, positive experience and confidence, unacceptable side effects and safety concerns, information, support and advice, and ongoing husband/partner influences.

CONCLUSION

The utility of clinical guidelines could be improved by incorporating socio-cultural factors and women's views. Novel approaches to evidence translation and facilitation are required. Focusing on user-led, age-appropriate services rather than a 'one size fits all' approach could improve the contraceptive choices and outcomes for women over 40 years old.

Catholics using contraceptives: religion, family planning, and interpretive agency in rural Mexico

Research on how religion shapes contraceptive practices and fertility has paid insufficient attention to how people interpret religious teachings. This study draws on ethnographic fieldwork in Degollado, Mexico, to describe generational and social-contextual differences in how women interpret and use religious doctrine to achieve their fertility desires without jeopardizing their standing as devout Catholics. Contrasting the family planning beliefs and practices of young Mexican women with those of older women (many of whom are the younger women's parents and in-laws), in a rural town in which the religious regulation of everyday life is pervasive, reveals how a common set of religious teachings and principles can be used to guide two different generational strategies for fertility regulation. The ethnographic data presented here highlight the creativity with which people use religious frameworks to justify their behavior. Research exploring how religion--and culture more broadly--influences fertility and contraceptive use should give greater attention to the dynamic interplay between cultural beliefs and institutions, social context, and interpretive agency. (STUDIES